Tag Archives: Psychology

January 13, 2025 · 9:51 am

Your handy psychological fact…might be false: Why we believe what we believe and what it says about us


Ever heard of Stockholm Syndrome? The psychological phenomenon where hostages begin to identify with and feel positive feelings towards their captors, maybe even to the point in helping them escape? For many this is accepted, even if rare, fact. It supposedly why kidnapping victims don’t try to run away when they have the chance or why domestic abuse victims stay with their abusers.

But, what if the concept behind Stockholm Syndrome is only based on assumptions, rumors, falsehoods, and repeated unscientific “trainings” offered around the world by experts. THIS is the case. I highly recommend you listen to this December 2024 episode of Radiolab. It just might blow your mind. Even if you have no interest in the history of Stockholm Syndrome, the applications to how we treat victims and how we simplify psychological explanations can do harm to others.

The problem of face validity

As you listen to this episode you will hear how the name for the syndrome was created without

  • Interview or study of the hostages
  • Verifying the “facts” that were frequently repeated as undisputably true (e.g., that the hostage wanted to marry the kidnapper when he got out of prison)
  • Replication studies

Why the wholesale acceptance at the public and even governmental level? Because it seemed to explain the behaviors of hostages. It made sense. This is what we call face validity. Makes sense…and is a false understanding. To quote HL Mencken, “Explanations exist; they have existed for all time; there is always a well-known solution to every human problem—neat, plausible, and wrong.”[1] 

The problem is, we (the public) don’t know that they are wrong and so we promulgate simple yet wrong answers. Listen to the above episode and you will hear recordings of the police trainer who trained thousands of officers and departments on how to handle hostages who likely will develop the syndrome. Listen to how confident he speaks. So, we believe him, because how could we know any better?

But this confidence puts the focus on the wrong place and causes society to pathologize the wrong person.

This reminds me of the era of the late 80s and 90s where so many experts appeared talking about the reality of Satanic Ritual Abuse. Turns out many of these experts where self-proclaimed. But, the problem seemed real enough to be possible, so some accepted SRA as valid because it seemed to fit a probable reality. Sadly, this social angst created victims—not just those convinced to make false allegations but those whose lives were destroyed by those allegations.

While we could write about WHY some people present themselves as being experts when their theories and interventions are not really supported with empirical evidence, I want to consider why WE are prone to believe them. We believe them because we need simple answers to allay our own fears as to whether we are okay.  

Heuristics make life easier…and are close enough, until they are not

Heuristics are a method by which we ignore complex information that might overwhelm us in order to come to a reasonable and timely decision. For example, you look up 3 websites to discover the best diet to try and you decide to try the last one (recency effect) to avoid information overload. Or, you listen to an expert talk about a subject and you generally believe them because they are talking about some recent research.

Let’s talk about a common heuristic that probably you have used that makes sense and seems to explain things about personality—Myers-Brigs Type Indicator (MBTI). Surely you have taken this test and found you fit one of 16 variations of 4 letters. The assessment tool tells you which side of the 4 categories you fall. You can easily summarize your personality by saying you are an ENFP or INTJ or the like. This makes it easier for others to understand what you are like and might even explain why you approach the world the way you do.

Simple, right? But the MBTI lacks adequate reliability (getting the same answer every time) and validity. What It does do is communicate some things well, hence why we use it. But it lacks significant empirical backing and should not be used as a tool describing personality. Why do we accept it? Because it is easy. And we don’t mind so much that it is actually rather weak in describing personality variants.

No one is really being harmed with being labeled as INTP. But what if a heuristic points us in the wrong direction and creates additional harm to a victim?

Why the Stockholm Syndrome heuristic sends us down the wrong path

Back to the Radiolab episode. Listen to Grace Stuart talk about why she stayed with an abusive partner.

Grace: …people don’t realize how much of domestic abuse is about confusion….confusion about what was even happening….What if I overreacted and made something out of nothing…

Sarah (interviewer): Whether to judge her ex by his good days or his bad days.

Grace: Is he the good guy or is he the bad guy? Is he kind or is he cruel? … Am I the perpetrator? Am I the narcissist?… Let me just change this one thing about myself.

Grace was looking to make sense of what was happening. To ask the why question. And she wasn’t asking so much about her abusive partner but about herself. What is wrong with me?

This is where the Stockholm syndrome answer takes us. What is wrong with the hostage or the partner who seems to be tied to the abuser? It has the focus on the wrong person. In the interview between Grace and Sarah, Grace’s voice fades out when she is about to answer what helped her change her point of inquiry. As the sound fades in the interview she mentions a book that helped her, “Why Does He Do That? By Lundy Bancroft. This book has helped many women better frame the questions from the why about themselves to the why and the what about their abuser.

You see, we are focused on the wrong person when we try to answer the question about why someone might stay in a bad situation. What if we changed our question to, “what do abusers do to keep people trapped.”

All explanations will fail. All theories will fail. So now what? Ask more questions

Nearer to the end of the episode, another story about a young man who was in the “Sarah Lawrence” cult. Daniel states that after he was able to get out of the cult, it took him 6 years to be able to process what happened to him. He says that he had to come to terms that he would never have a satisfactory answer to the “why” question. And that he had to come to terms with the factors in why he stayed were complex and the tools he had to make decisions at that time were limited.

What is his solution? Keep asking curious questions about human behavior. “Be suspicious of any concept which doesn’t invite further curiosity.” “If it is a thought terminating answer…anything that ends our curiosity is bad.” So, he invites people to ask, “what helped you leave?” rather than “why didn’t you leave?”

Concluding thought

If you have read this far and listened to the podcast (if not, I remind you to not miss it!), take a moment to consider what easy explanations you might be using about yourself or others. Can you allow yourself to accept the answer, “Its complicated” to the why question. Now, try to move on to some different questions.

  • What can I do to make the moment better?
  • Who might I be able to enlist to help me understand my options?

And when someone offers you a simple (simplistic) solution (e.g., “just breathe” or “just leave” or “just eat better”), smile and look for those who can sit with complicated things and help you decide the next one move to make.  

[1] Prejudices, Second Series, p. 158.

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October 29, 2023 · 12:57 pm

Am I doing this Trauma Healing Thing Right? Part 5, Finding a therapy and a therapist


So, now that we have identified some barriers to recovery (myths and red flag moves by helpers) and noted essential items you need for this journey—like compassion and curiosity, let’s conclude this series by exploring how to choose a therapist and a model. 

It can feel impossible to find a quality therapist and downright overwhelming to choose a particular model of trauma care. If you have started to look you probably began first to explore credentials and general styles of therapy (models). 

Do you choose Christian or biblical or secular? How much does licensing and credentials matter? 

Which model? CBT, TF-CBT, DBT, PE, EMDR, Tapping, CPT, Brain spotting, NET, PFA, Debriefing, and somatic psychotherapy? Neurofeedback? IFS?

Medications? Ketamine? Transcranial magnetic stimulation?

Or maybe skip the therapy altogether and focus on yoga, mindfulness, meditation, art, or acupressure?

Feeling overwhelmed yet? 

If you have been looking for very long, you probably heard someone sing the praises of one of these types of therapists or models over others and noted it to be a miraculous cure for them. And just as likely you have heard, “that didn’t work for me.” 

Cutting through the fog

Several of the models listed have some scientific support. And some others have a lot of hype and anecdotes but little in the way of actual substantiated research. Randomized control trials, the gold standard of research, attempt to look past correlational data to determine if a positive result can be attributed to the intervention used. Sometimes we learn that a particular model is effective even while we do not fully understand why or what part of the model is having a positive impact. But, it should be noted that many RCTs tend to be small in sample size and somewhat limited in generalizability. In other words, it worked for the research group but until it is replicated many times with different populations, we won’t yet know if it works for most or for you or me. 

One more frustrating part is that disciples of a model may suggest to you that an intervention they use is more successful than the researchers who developed and studied said model. We have this annoying habit of overestimating the value of the thing we have learned to do. 

Pick your person first

So, don’t start with which model you should choose from. Yes, models and ideologies matter and influence the work done in session. But there is something more important to consider. It is…drum roll…the character and person of the counselor. Trust and connection in therapy has more to do with success than the model being used. We have already identified the characteristics of a good therapist in the last post: 

  • Goes at your pace.
  • Is curious about what you need. 
  • Wants to learn what helps you more than tell you what you should do.
  • Is aware of and adjusts when you are overwhelmed.
  • Invites your pushback and doesn’t get defensive.
  • Listens more than talks.
  • Checks in to make sure you are talking about the things that matter to you the most.
  • Does not criticize your faith journey.

If you have such a person now, ask yourself if you are holding back. Don’t judge yourself if you are, but ask what it might mean. It may mean there is something you are not ready to talk about. Good for you to know what you need. It may mean there is some bit of safety that still needs to be built in the session. It may mean something is off in the therapy. See if you can find a way to discuss this dynamic without talking about the thing you are holding back. How your therapist navigates this bit of information will tell you much about the safety and trust in the relationship. 

But I don’t have this person yet, how do I find them?

I recommend you start by asking people who you trust, who they have heard does good work. Get firsthand reports whenever possible. You want to ask, 

“Who would you go to or send your family member to if you knew they needed a good therapist? What makes them a good therapist?”

Once you locate someone who seems to fit the bill—experience…known to be a good listener…has credentials and training—you will still need to find out if this person is going to be right for YOU. 

Once you get an appointment, interview them in that first session and keep in mind these questions as you progress in your therapy. 

  1. What models/authors do you most likely follow?
  2. What are early signs that therapy is working? Signs that maybe something else is needed?
  3. What do therapy sessions look like? Hopefully, their answers include some form of:
    • Grounding/calming. Before/during/after triggers in session and practiced at home. It should be tailored to your needs and flexible. 
    • Small exposure to trauma via your story—not rushed in the therapy process—with more grounding sandwiched around the exposure. This should be well-planned and short, and not a whole session focused on traumatic stories and triggers. The goal is not reliving trauma but remembering, lamenting, and then shifting weight to the present.
    • Narrative or meaning focus (who am I? who is God? Was it my fault?). Exploring and grounding in new narratives This often comes later in therapy work.  
    • Grief work. Most therapies will have some exploration of grief and lament. Naming what was lost and what has been suffered is necessary for good healing.  
    • Finding and celebrating strengths and resilience. An important part of recovery is seeing where and how you have grown and developed new capacities. 

But, what model should I be looking for?

I won’t be able to tell you what works for you. But use the following questions to determine what works for you now. It might be that you need one supportive therapy now and a different one later. 

  • Are you struggling with being on high alert all the time? Do you want to find something that helps you calm your body? Consider something that helps you practice calming and stabilizing your body. Somatic psychotherapies that follow work by Janina Fisher may be most appropriate for you. 
  • Are you a writer? Consider more narrative focused treatment like NET or CPT. 
  • Do you find yourself stuck in patterns of bad relationships and self-harming behaviors? Consider a DBT oriented group or therapist.
  • Do you find yourself in a frozen state (vs flight/fight/fawn)? Consider something that is less exposure oriented. You may find that certain exposure-oriented interventions (CBT/EMDR/PE) are unhelpful in early phases. Similarly, if you have many traumas versus one, consider something that goes much more slowly and helps you stay connected to parts of yourself. You may find that someone who follows the work of Diane Langberg or Judith Herman is a better fit for you. Also, the work of IFS can help you make some safe room for exiled/shamed parts.   

Concluding thought

The work of trauma recovery is slow, repetitive work. You learn something, then need to learn it again. You feel some growth,  and then feel yourself slipping, especially when you hit anniversaries and reminders. Give yourself permission to keep trying old and new things. 

The journey of recovery (whether in therapy or just waking up to another day) is an ongoing reminder that something has died. Maybe for you it is a relationship or trust or a body that didn’t bear the invisible wounds. You will grieve these things. Try to grieve without confusing grief with shame and guilt. You may have to relearn that grief does not mean shame. 

Remember also that your journey will show you that you are still alive. You survived. Slow your breathing and feel your aliveness. Feel your aliveness—even the pain—telling you that you are here, and you reflect courage and beauty. Take note of the small things growing in and around you. These are the bits of beautiful creation that tell us you reflect God’s glory. You may not feel the beauty but consider that it is still true. 

For further reading about the healing journey, consider reading “Wounded, I am More Awake.” You can read my thoughts on this book beginning here.

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October 23, 2023 · 6:31 am

Am I doing this trauma healing thing right? Part 2, Myths about healing that hinder recovery


In my previous post, I explored how chronic trauma responses lead many of us to think we are doing something wrong and are the reason why we are not getting better fast enough. We named some foundational principles for recovery, landmarks by which to navigate the journey of healing.

  1. Take care of your body.
  2. Look for stability in a triggering world.
  3. Begin (again and again) to tell the story of you.

These three steps are seemingly simple and yet they take every fiber of our being and the help from friends to keep fighting for healing day after day.

Unfortunately, there are some beliefs about healing—myths—that can hinder our recovery journey. As you read my shortlist of 4 misguided views about suffering and healing, consider what beliefs and ideas you have had about healing (or heard from others) that might create an extra barrier in your own journey.

Myth: Complete healing is possible and likely

There is a myth that healing from trauma means that I will no longer be bothered by things that used to trigger me. Healing means, in this belief, that memories will not be painful or show up at surprising times. If I continue to have triggers, these reactions are signs of failure to heal, to trust, to have faith in God.

Sadly, I see many who have found considerable healing after trauma to believe this because they have surprising triggers that knock them off their feet from time to time.

Consider this analogy, Your body has changed as much as if you were hit by a car. If you had been an elite athlete prior to the accident, you might need to accept you could no longer be an athlete as a result. It would not be a sign that you had failed to heal but that in healing, life is now different. When we believe that something is wrong with us since we bear scars (e.g., trauma triggers, bodies that are on higher alert, limitations to what we can now do) we add to our pain by accusing ourselves of not healing.

It doesn’t help when we see others who seem to have found more healing. Stories of “heroes” like Corrie Ten Boom or Malala Yousafzai seem to tell us that some people are truly healed. And since we know we are not, there must be something wrong with us. Truth? While post-traumatic growth is a real thing, there is ample evidence that these heroes still suffer with their invisible wounds. Growth does not eliminate injury.   

Myth: Healing should mean no longer in grief

Grief and growth will co-mingle, and one does not eliminate the other. Loss is loss. When we experience trauma, we also suffer loss. And loss means grief. These losses include safety, predictability, identity, voice, as well as other more physical and spiritual losses. We may lose family members, community, and capacities we once had (recall the elite athlete image above).

We don’t imagine that if you lost a close loved one that you should no longer feel something when reminders of their loss are present. Grief shows up like waves at the ocean. They may be big and knock us down. They may be small and less obvious to us. No matter the size, they are always present. And something will likely trigger a larger wave when we least expect it.

Myth: My faith should be able to be what it was

The story of you has changed as a result of trauma. It impacts every part of your story, including your faith and spiritual experiences. By every definition, you are now different because your story includes something that is difficult, if not impossible, to integrate into the way life was or is supposed to be.

Consider the Psalmist in the Bible. Psalm 42 and 43 tell us this fact in poetic form. The writer struggles to make sense of the loss of his capacity to lead the worship procession. He remembers how led the way to worship but now all he feels is isolation and the sting of those who mock him. He cannot find his way back to who he was and his efforts to press himself to trust God seem not to work. In the end, he is left with big questions for God.

If your trauma happened within your faith community, you may not be able to return or to worship in the same way. Even if you do return to your faith community, joy will likely be tinged with grief. Because you, like the psalmist, are trying to integrate a new disconcerting reality into your story. This new struggle is not a sign of failure to heal. It is a sign that things are now different. And remember, this struggle does not mean you do not have faith or trust God. The act of lament is just as faithful and worshipful as singing praise songs with a crowd. (To read more about lament, try this short essay.)

Myth: Suffering is God’s way of strengthening me

A common myth in Christian circles is that God has some master plan that includes suffering and without it, God could not prepare you for greatness or strengthen you. I see this myth at play when people minimize their suffering and try to whitewash it with phrases like, “but it is all for the glory of God.” Yes, God does get glory when his people seek him and honor him. And, suffering may indeed strengthen new parts of your being, in time. You may thank God for his presence in suffering and for his various ways of showing up in hard times. You may find hidden treasures in dark places (Is 45:3) and discover new strengths you did not know you had.

However, God’s heart for hurting people tells us that suffering is NOT his master plan. When suffering entered the world, God’s master plan was to pursue lost people (Gen 3:9, 21) and to care for them.

Suffering is suffering. Evil is evil. It is never good even if you find something good along the way to recovery. And no such positive outcome dismiss the suffering you have gone through. Our pain and our healing is not some balance sheet looking for a positive tally.

What are some of your beliefs that add to the pain and shame you are now experiencing? What can you release or begin to doubt? If you have a close friend who will listen and ask good questions, consider talking to them about some views on healing that might be holding you back.

A final thought about healing

Healing happens little-by-little. Of course we want it to happen now. You are not alone to long for more healing and less pain. There are things that can help and we will cover that in a future post in this series. I want to leave you with a garden analogy. In front of my office, there has been a lovely Japanese Maple tree. The leaves have been exquisite every fall. But this year, a big portion of it died and so had to be cut down. The spot there is now bare. I feel it’s absence every day. the building looks exposed now. Some small shrubs have been planted in the spot and lovely as they are, they cannot replace what was lost. And yet, when I stand there, I can see small growth and beauty of a different kind. The story of the building is certainly different. I see the stump and the growth that is happening.

You are a garden that had many beautiful things in it. Something happened to the garden of you and now the losses overwhelm any sense of goodness. You must now reconsider what the garden will be like going forward. Give yourself time to grieve what is no more and take time to notice what life is possible in you.

What’s next?

In part 3, we will explore another barrier we face on this journey of healing: the harmful actions of “helpers” and guides. We will look at some red flags you might see in your counselors, therapists, and spiritual guides.

Read more about healing on this site using the search bar. Try this video. Reconsider the language of healing. Would “integration” be a better way to describe recovery after trauma?

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October 21, 2023 · 3:18 pm

Am I doing this trauma healing thing right? Part 1, an overview


I spoke last week at #Restore2023 hosted by the julieroys.com. This was their third such conference and the second I have attended. I decided to present on this question in the title because so many ask me about their healing journey with the assumption that they must be doing it wrong. Why? Because they are continuing to struggle with triggers and can’t seem to “move on.” This very question often adds to their pain because of the assumptions of failure.

Trauma is a deep wound of the heart and it hurts every part of our being–our hearts, minds, and bodies. It disconnects us from ourselves, our friends/family/community, and from our faith. We are often are left with two enduring questions: Why did this happen and how can I get out of this hell? Sadly, we end up believing that WE are likely the cause of why we are traumatized and that WE are likely the reason why we aren’t better yet. Trauma triggers and responses are impossible on their own. But the overwhelming sense that we are the reason we aren’t getting better only amplifies the pain. And when our “helpers” add to our own self-criticism by saying or inferring we aren’t doing it right, we feel even more sure that we are alone and forever trapped in a death spiral.

In this little series I want to explore some features of this necessary but unwanted journey of healing. We’ll start by orienting with a small “map.” In later posts we will explore some barriers to recovery and red flags to take note of regarding your helpers or counselors. We will end the series by considering what model of therapy and therapist might be best for you.

The journey you never imagined you would have to take

When you begin a journey these days, one of the first things you want to have is your turn-by-turn directions on your smart phone. But this journey is going to be a bit more old-school since google maps has yet to give us the quickest route. Before cell phones, we had to have a paper map and/or some scribbled directions to remind us key landmarks that would help us find our way to our destination. True old school would be orienting by sun and stars and this may be the best image to keep as you navigate your own path of healing.

So, what are some landmarks (aka, basic reminders) that help us stay on the right path? Consider these three:

Take care of your body.

Our whole beings have been damaged—it is not just in our mind! So, we need to take care of our bodies. Part of caring for bodies means understanding them and having non-judgmental curiosity about how your body works. For example, your body is designed to protect you. You sweat when you overheat. and shiver when cold. Your body defends against viruses and germs. The trauma response you experience in your body is an attempt to protect you. So, do your best not to think ill of it. Recently, I suffered a back injury and spent a few days immobilized due to spasms. My back muscles, even my whole body, tried to keep from feeling those spasms. We call that guarding. I was able to get help and began some PT a few days later. The protective muscles had done their job but now needed reminders to go off duty as their protection was not needed anymore. The therapist gently reminded me to relax my glutes and calf muscles as we worked on my back.

For many of you, your body has been guarding from a long trauma in your life. No wonder it responds the way it does. Acknowledge its effort and give thanks for its amazing capacities. Use gentle reminders and compassionate care.

Look for stability in a triggering world.

Part of caring for our bodies it to develop a curiosity about what helps us find stability in a triggering world. If you are continually attacking yourself for having a fight/flight/freeze response it will be hard to develop curiosity about what helps you recover that sense of security and stability.

What helps you experience just a little more ease after a trigger? Maybe for you it is movement. For another, it may be a specific breathing exercise or a focus on one of the senses. Or, maybe it is a distracting conversation with a friend. Figure out what helps even just ten percent and develop a list of things you can try when distressed. Don’t beat yourself up if you can’t remember what to do but find ways to write it down so that it is easier to remember. Something might work once and not another time. Again, just take note of it without judging your capacity to calm yourself.

Begin to tell the story of you again.

A key feature of recovery is the practice of beginning to tell (and write new chapters) the story of you to yourself and others. Trauma has a way of stealing our voice and power. It has a way of distorting our story and giving us false names for what we have experienced. “If only I was stronger I could have resisted him…I must have asked for this abuse…”. The journey of healing is a journey of making some sense of the insensible and reframing who we are in the world. This takes time and needs lots of care. it ought not be rushed but done little-by-little. However, even when you go out with friends and do a small but brave thing, you are writing a new chapter in your story. Make sure you aren’t missing this important fact.

three simple steps, right? Not really. Exhausting? Absolutely.

In our next post we will get into greater detail about this journey towards healing. But, first, there are some barriers to the journey that can hinder our progress. These are things we and others believe and some things others do that get in the way of our making progress. Some of these myths really delay or disrupt. We’ll cover some of the myths about the healing journey in our next post.

For more reading on this site, search the word “trauma” or start with this post.

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November 18, 2022 · 7:21 am

Beauty in Garbage City: A Webinar Series with Dr. Diane Langberg


I want to let you know about an opportunity to engage with Dr. Diane Langberg and myself, designed especially for people helpers–mental health professionals, pastors, caregivers, and friends of those who are traumatized. Please read on if you are interested (link to register here):

The work of counseling and pastoral ministry is not “nice.” If you follow Jesus into the hard places of others’ lives, expect it to have an impact on you; to challenge your strongest held beliefs about God and the Church, your views on mental or emotional health, and your personal well-being. Join Dr. Diane Langberg and host Dr. Philip Monroe and learn from Dr. Langberg’s five decades of work with hurting people and broken systems. Listen as she talks about what has sustained her and answers your questions about what has helped her grow.

How do we continually sit with trauma and survive its impact? We will explore a specific concept during each of the three webinars:

January 15: Finding beauty means opening your eyes to the problems that are inherent as caregivers in the work of trauma. Followed by Q&A.

January 22: Embracing beauty is developing your primary helping tool: character and learning. Followed by Q&A.

January 27: Becoming beauty is applying what we have learned to trauma recovery work that leads to becoming the beauty of our Savior amid the piles of rubble and ruins we encounter every day. Followed by Q&A.

The 3 webinars will be three Sundays in a row, January 15th, 22nd, and 29th, 2:00pm-3:15pm Eastern Time. These webinars will include a Q&A portion, giving the audience an opportunity to ask Diane questions.

Cost and registration includes access to all 3 webinars. Registrants will have access to the Zoom webinar login information by January 9th, either via email or by visiting the online event page. Early Bird ticket price is $30 before December 25th, and $50 after that date.

NOTE: All three sessions will be recorded and emailed to every registered participant.

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June 30, 2017 · 5:32 am

Single session debriefing sessions? Helpful or harmful? 


I write this from Uganda having just completed a Community of Practice conference hosted by the Ugandan Bible Society. This community of practice is for bible-based trauma healing facilitators and local mental and public health experts. I presented on an update to PTSD causes, effects, and treatment. We looked at the value of Scripture engagement around the topics of trauma, loss, and recovery as well as how it fits into the larger picture of trauma counseling. 

Much of what we clinicians know and do for treatment for PTSD symptoms is based on partial research but a significant dose of “clinical judgment.” What is that? Well, it is treatment models that may have some empirical support but mostly formed over long-held assumptions in the field. One of those assumptions is that we may be able to prevent PTSD if we provide group or individual debriefing sessions soon after a traumatic experience. These debriefing sessions have been offered for decades to first responders, humanitarians, and missionaries after exposure to traumatic and tragic events. In recent years we have seen some evidence that some may not be helped but these sessions. In fact, some may even be harmed. 

The evidence of possible harm is not new. Yet, debriefing is still offered indiscriminately. We find it hard to let go what seems to work. Today I was able to read a 2006 study published in the British Journal of Psychiatry (citation below). This bit of research compared emotional debriefing, educational only debriefing, and no treatment. This study of Dutch civilians who had experienced a single episode of trauma within the last two weeks found that all three groups (emotion oriented debriefing, education only, and no treatment) saw a decrease of symptoms at 2 and 6 weeks post intervention. There was no benefit from either form of debriefing found in this study. 

In addition to no benefit, those individuals with high arounsal trauma symptoms who completed emotional debriefing showed higher rates of PTSD symptoms than the those with higher arousal who did nothing or only the educational oriented debriefing intervention. So, some forms of debriefing may actually worsen symptoms. Why? The authors surmise, 

In previous studies it has been established that high degrees of arousal in the immediate aftermath of a traumatic event are associated with an increased risk for the development of PTSD, measured both by self-report (Carlier et al, 1997; Schell et al, 2004) and physiologically by means of heart rate response (Shalev et al, 1998; Bryant et al, 2000; Zatzick et al, 2005). Encouraging highly aroused trauma survivors to express their feeling and emotions concerning the trauma might activate the sympathetic nervous system to such a degree that successful encoding of the traumatic memory is disrupted. Moreover, during an emotional debriefing session negative appraisal of one’s sense of mastery may be promoted (Weisaeth, 2000). This is assumed to keep the hyperreactive individual in a state of high arousal which may cause symptoms of PTSD to escalate rather than resolve (McCleery & Harvey, 2004). 

So, what should we do with this information? Nothing? No. But what we do should not harm, especially when we know some may be harmed. I suggest a few possible outcomes:

  1. Education about PTSD and trauma should continue. This study does not reveal harm for this intervention and given the relatively low trauma symptoms in this study (and the possibility some may have already been aware of what trauma is), education is likely to be helpful. Education is not only about trauma but also about good coping skills and activities. It does not focus on the events of the trauma experienced.
  2. Bible-based trauma healing begins not with a person’s story but looks at culture and common reactions. It normalizes pain and suffering and connects people to God and others. We do not yet have great empirical evidence (it is being collected) that such an intervention is helpful or harmful. But it appears that giving people permission to ask questions of their faith and to see that God encourages lament may still be helpful. 
  3. We need assessment of the growing movement and art oriented responses to trauma. What do these non-talk therapies add to the prevention or intervention strategies? 
  4. Debriefing or talking about a trauma that has just happened should focus less on replaying the details and more on current cognitive and affective impact with focus on resilience and boosting existing capacities. Brief assessment of arousal symptoms may well be warranted by those who promote processing trauma stories. This may be why NET, CPT and DBT oriented PE have lower drop-out rates than classic PE (prolonged exposure) therapy. 

Citation: Emotional or educational debriefing after psychological trauma (Randomised controlled trial) by MARIT SIJBRANDIJ, MIRANDA OLFF, JOHANNES B. REITSMA, INGRID V. E. CARLIER and BERTHOLD P. R. GERSONS. In BRITISH JOURNAL OF PSYCHIATRY (2006), 189, 150-155. doi: 10.1192/bjp.bp.105.021121

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November 11, 2015 · 7:00 am

Do men need sex? Wants vs. needs and the making of weak men


A bit ago, I wrote a piece challenging Michelle Duggar’s advice to her newlywed daughter about how to be sure to always be ready for sex.

“And so be available, and not just available, but be joyfully available for him. Smile and be willing to say, ‘Yes, sweetie I am here for you,’ no matter what, even though you may be exhausted and big pregnant and you may not feel like he feels. ‘I’m still here for you and I’m going to meet that need because I know it’s a need for you.’ ” (emphasis mine)

That advice, in my opinion, makes men out to need sex to such a degree that the lack of it will lead to bad things like porn and adultery. Sex is treated as the glue that holds fragile men in the marriage and the lack of it kills the marriage because men can’t function without it.

Interestingly, comments on that blog and other social media, by women, suggested that indeed sex is a need, not just a want.

Now, I just read a piece by a not-surprisingly anonymous blogger entitled, “How a husband can enjoy sex that is grudgingly given by his wife,” which argues much the same thing. While there are a million things wrong with his post, I only want to highlight the “need” language used in it. When illustrating how a wife might be allowed to (rarely) turn down her husband’s request for sex, he suggests she use this line with him,

“Honey, I know you really need it, but I am just really sick tonight, can I make it up to you tomorrow?” (bold mine)

And when he talks about the problem of the wife not wanting sex the way the husband wants,

But then we have the conundrum, women don’t always feel like having sex. Even women that have a healthy view of sex don’t always feel like having sex as much as their husbands do. (emphasis his)

One could argue that for some this is true, some men feel greater sexual desire than do their wives. But it is only a conundrum if such feelings/desires for sex are evidence of some innate need that if not met will lead to trouble.

Maybe from this quote you are not sure that this blogger believes sex is a need for men. Well, he also believes it is a need for women as well,

You need to realize that this is a physical need that you have as a man. You also need to realize that whether your wife knows it or not she needs to have sex too. Your marriage needs sex at regular intervals. If you don’t have sex with your wife at regular intervals, even sometimes when she is not in the mood but consents anyway, you will open yourself to temptation. You will find yourself becoming distant from your wife, because this is the primary way that you as man feel closeness with your wife.

But even if you realize and accept this truth that you need sex and it needs to happen even if your wife refuses to “fake it” and bury her wrong attitude then what?

What is probably most controversial in this blog is that he advises men to go ahead with sex when a wife is giving sex in a grudging way. He recommends that a husband not look at his wife’s face but focus on her body. You see, sex is such a need, it would be best to just muscle through it, don’t look at her face, so you can fulfill that need. Really!

Is it a need? Is it a want?

So is sex a need? Even if you believe it is a duty to provide sex to your spouse, does that make it a need equivalent to, “if I don’t get oxygen, I will die”?  Will the absence of it lead to bad things? It seems that some have  bought into this little formula: SEXUAL DESIRE = NEED. UNMET NEED = DANGER that will lead to  temptation, straying, or some such pathology.

What do we do with single men who want to be married? Is God unkind to them?

I think our troubles begin this way: We often baptize desires as needs, expect needs to be fulfilled, are angry when they are not, make demands of others to fulfill our wants and excuse ourselves when we use illicit means to get what we want (either by outright force, manipulation, or secrecy).

Notice here the author conflates desire with need. Yes, many men and women desire sexual activity. We are designed for it so it is not surprising when we like it and want more of it. But it is also designed to be used to connect us with our spouses. And when it is used to only fulfill one person’s needs, then it is not being used as designed.

And when we see it as a need, we are encouraging men to see themselves as weak and incapable of living without sex.

Further, arguing backwards does not make it a need. For example, you could show that those in sexless marriages are more likely to cheat (example; I don’t know if this is true or not). This information still does not make sex a need. At best it can only tell us it is a powerful want.

Consider for a minute how we might respond to these two different equations:

  • Sex as basic need + unmet need = ???
  • Sex as powerful want + unmet want = ???

How would you conclude these two equations? The first is more likely to focus on ensuring the spouse is not selfishly withholding such a basic need. The second is more likely to be concluded by addressing the one who has the want and how they plan to address that want.

A Better Equation

Maybe this is a more accurate equation: Sex as a powerful want + partially unmet wants + brokenness (bodies, relationships, desires) = grief over losses + opportunity to rely on Holy Spirit + pursuit of loving our spouses more than ourselves. This equation better acknowledges wants, sadness the happens when wants are not met, the reality of broken wants and broken bodies but also points to a better goal of reliance on God and the focus of love more than getting something.

It is painful to have unmet wants/desires. Those desires do not have to be wrong (though we are never fully right either). But our wants are always given to God and made secondary to our command to love the other well. Yes, part of loving the other may be talking about desires and hurts. But surely let us get rid of the idea that failing to have sex leaves men or women in some greater danger than those who have sex as much as they want.

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October 31, 2015 · 11:23 am

Should you get a doctorate in counseling or psychology?


Over at the BTS faculty blog, I’ve written about the pros and cons of getting a doctorate in a mental health field. Of course, I focus on what I know and play to my biases. You can read that post here.

That post is missing a link in the first paragraph. Here’s the link to the APA book.

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September 25, 2015 · 6:00 am

Useful Book on Narcissism


Craig Malkin of Harvard Medical School has written a popular, easy to read book on the topic of narcissism and its opposite end of the spectrum, “echoists.” Rethinking Narcissism: The Bad–And Surprisingly Good–About Feeling Special (Harper, 2015) is worth your read if you think you might be on the spectrum or if you live with someone who does.

In the beginning he sets out to destroy the myth that narcissism is always destructive and that all narcissists act the same. To help describe the continuum of egocentrism Malkin defines the low side as “echoists,” those who have too little of it who feel special in becoming invisible to others only known for the help they offer to others. Further, he also describes narcissism as something that may ebb and flow, rather than a consistent trait. Malkin describes the continuum well with many real life examples. With a better understanding of the spectrum, it may help us look more closely at less pathological forms of egocentrism and be less likely to lump everyone together.

Worried that you might be a narcissist? Want to see where you fall on the spectrum? Try out his assessment tool.

In his book he describes the root causes and the experience of being around subtle and extreme forms. Unlike other researchers, he outlines ways that egocentric people can grow empathy toward others. This idea flies in the face of conventional wisdom that a narcissist can never change,

The problem is we’ve all had it drummed into our heads that narcissist can’t change. They think they’re perfect just the way they are, the argument goes, so why should they even try? But unquestioningly accepting this idea backs us into an impossibly tight corner….We’ll fall silent or vent our anger, or…we’ll try a little of each. And none of these reactions will make the relationship any healthier

When we withdraw, by swallowing our words or walking on eggshells, we only strengthen people’s narcissism. In fact, echoists and narcissists often pair up to create a “love” that’s toxic to them both.

What can we do? For those who are not extreme narcissists, one way to encourage growth is to validate their experiences even while we say “ouch” letting them know we are hurt. Too often our anger or our silence is the primary response. While validation and pointing out our pain is not a guaranteed solution, combining validation plus vulnerability can enable some to experience compassion for self and other at the same time.

Check out the book!

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January 27, 2015 · 1:49 pm

How labels we use reveal self-deception


 

Someone sent me one of Ken Pope’s summaries of a recent essay about the differences in research findings when asking men if they have ever used force and held someone down during sex versus asking them if they had ever raped another person. You can read the original research he was discussing here, which is by some researchers at the University of North Dakota.

No, I’m not a rapist, but I have used force to make someone to have sex.

Let that previous line sink in a bit.  We’ll discuss it in a minute. But first, you might not want to read the article so let me tell you what the authors were interested in knowing. They wanted to know if there were differences between men who are hostile towards women and accept the label of rape and those who have used force but deny the label.

This allows us to test whether there are differences in men who do not identify with the “rape” label on sexual aggression surveys, although they have committed acts that would be defined as rape. Men who admit intentions to force women to have sexual intercourse only, but do not believe that this act constitutes rape, might not be primarily motivated by a desire to retaliate and overpower women. Their behavior could be guided by other factors in line with stereotypically masculine gender roles such as having a high desire for sexual activity, viewing sexuality as a competition and a way to gain respect among peers, and lacking consideration for women or viewing them as sexual objects. Therefore, we hypothesize that men do not endorse any intentions for sexual aggression will differ from the other two groups of men primarily on a dimension characterized by hostility toward women as the strongest loading factor. (emphasis mine)

What did they find?

As hypothesized, a sizable number of participants indicated that they might use force to obtain intercourse, but would not rape a woman. Men who indicate intentions to use force but deny intentions to rape exhibit a unique disposition featuring an inverse construct of hostility toward women but high levels of callous sexual attitudes (Check 1985). Given that hostility toward women involves resentment, bitterness, rejection sensitivity, and paranoia about women’s motives, we consider the inverse of hostility toward women in men that intend to use force to be indicative of an affable, trusting, and nonreactive affect toward women. When combined with callous sexual attitudes, we interpret this function as representing personality characteristics that might lend themselves to allowing men to not perceive his actions as rape and may even view the forced intercourse as an achievement. The primary motivation in this case could be sexual gratification, accomplishment, and/or perceived compliance with stereotypical masculine gender norms. The use of force in these cases might be seen as an acceptable mean to reach one’s goal, or the woman’s “no” is perceived as a token resistance consistent with stereotypical gender norms. While the ultimate outcome of either act constitutes rape, this pattern of results suggests that there might be different types of offenders with potential differences in underlying motivation, cognition, and/or personality traits.

So, not every rapist does so for the same motives (and therefore our interventions will need to be different). Some knowingly rape and are not self-deceived about their actions. Others who are willing to acknowledge “forceful intercourse” group reveal deceptions  (probably both in view of self and other) that enable rape to be considered something less than it really is.

Labels and what they may reveal

What labels do you use and what do they reveal about yourself and your proclivity to self-deceive? Here are some examples

  • I exercise (once in a great while)
  • I stand up for myself (I attack anyone who disagrees with me)
  • I used to struggle with porn (well, I look about once a month but I don’t think I will do it again)
  • I eat healthy (I’m obsessed with food labels)
  • I am good at doing my taxes (I underreport income)
  • I’m a Christian (I go to church but never really talk to God)
  • Let’s just call it sin rather than abuse (because I won’t accept my actions are abusive)
  • I need (I want/demand)

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